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Disease Markers
Volume 31, Issue 2, Pages 91-100

Analysis of Sputum Markers in the Evaluation of Lung Inflammation and Functional Impairment in Symptomatic Smokers and COPD Patients

Gregorino Paone,1,2 Vittoria Conti,3 Annarita Vestri,4 Alvaro Leone,5 Giovanni Puglisi,6 Fulvio Benassi,6 Giuseppe Brunetti,6 Giovanni Schmid,2 Ilio Cammarella,7 and Claudio Terzano3

1Department of Cardiovascular and Respiratory Sciences, ‘Sapienza’ University of Rome, S.Camillo-Forlanini Hospital, Rome, Italy
2IRCCS Fondazione Don Carlo Gnocchi–Onlus, Rome, Italy
3Department of Cardiovascular and Respiratory Sciences, Respiratory Diseases Unit, ‘Sapienza’ University of Rome, Fondazione E. Lorillard Spencer Cenci, Rome, Italy
4Department of Public Health and Infectious Disease, ‘Sapienza’ University of Rome, Italy
5Pathology Unit, S.Camillo-Forlanini Hospital Hospital, Rome, Italy
6S. Camillo-Forlanini Hospital, Rome, Italy
7Department ‘Attilio Reali’, ‘Sapienza’ University of Rome, Italy

Received 31 August 2011; Accepted 31 August 2011

Copyright © 2011 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The pivotal role of neutrophils and macrophages in smoking-related lung inflammation and COPD development is well-established.

We aimed to assess whether sputum concentrations of Human Neutrophil Peptides (HNP), Neutrophil Elastase (NE), Interleukin-8 (IL-8), and Metalloproteinase-9 (MMP-9), major products of neutrophils and macrophages, could be used to trace airway inflammation and progression towards pulmonary functional impairment characteristic of COPD.

Forty-two symptomatic smokers and 42 COPD patients underwent pulmonary function tests; sputum samples were collected at enrolment, and 6 months after smoking cessation.

HNP, NE, IL-8, MMP-9 levels were increased in individuals with COPD (p < 0.0001). HNP and NE concentrations were higher in patients with severe airways obstruction, as compared to patients with mild-to-moderate COPD (p = 0.002). A negative correlation was observed between FEV1 and HNP, NE and IL-8 levels (p < 0.01), between FVC1/FVC and HNP, NE and IL-8 levels (p < 0.01), and between NE enrolment levels and FEV1 decline after 2 years (p = 0.04).

ROC analysis, to discriminate symptomatic smokers and COPD patients, showed the following AUCs: for HNP 0.92; for NE 0.81; for IL-8 0.89; for MMP-9 0.81; for HNP, IL-8 and MMP-9 considered together 0.981.

The data suggest that the measurement of sputum markers may have an important role in clinical practice for monitoring COPD.